Diabulimia and Type 1 Diabetes: An Unknown and Emerging Problem.

BACKGROUND: T1DM patients have a higher prevalence of eating disorders than the general population, and up to 30-40% of young T1DM patients suffer from an eating disorder, including diabulimia. Eating disorders worsen glycemic control and make insulin therapy management more difficult. Closed loop systems (HCLS) allow major therapeutic flexibility; however, proper carbohydrate (CHO) counting remains a fundamental feature for insulin dose adjustments. CASE REPORT: A 30-year-old female patient affected by T1DM (with a past medical history of drug abuse and depressive syndrome) presented with inadequate glycemic control and prandial boli management. She started a CHO counting course and had a HCLS positioned, with progressive amelioration of glycemic control. During follow-up evaluations, HCLS data showed a progressive reduction and abeyance of prandial boli; the patient also developped an excessive fear of weight gain. An integrated approach between diabetologist, psychiatrist and dietitian allowed a diagnosis of diabulimia, an eating disorder characterized by a progressive reduction and elimination of carbohydrate ingestion and insulin boli, with episodes of uncontrolled binging and purging. A multidisciplinary approach (fortnightly dietetic and psychiatric evaluations, use of bioimpedance, fixed CHO content diet) allowed the patient to reach a better glycometabolic control and disease consciousness. CONCLUSION: T1DM patients need to pay great attention to food quality and quantity; hence, an eating disorder diagnosis may be challenging. Additionally, there are currently no standard screening methods for this purpose. In our experience, an integrated approach is fundamental and may be a valid strategy to face this emerging problem.

The role of diabetes distress in Diabulimia.

IMPORTANCE: Diabulimia is a disordered eating behavior in which a person with type 1 diabetes withholds insulin injections to lose weight. It is thought that the psychosocial stress of managing this chronic disease, which is termed diabetes distress, may contribute to developing diabulimia. OBJECTIVE: This paper explores links between diabetes distress and diabulimia and their relevance to the diagnosis and treatment of diabulimia by assessing whether people with diabulimia report measurable evidence of diabetes distress. EVIDENCE REVIEW: We evaluated studies examining the qualitative experiences of people with disordered eating behaviors in the setting of type 1 diabetes for themes of diabetes distress by identifying aspects of the patients' stories that matched the criteria in the Diabetes Distress Scale. Selected studies recorded primary data, analyzed qualitative data, examined lived experiences of individuals with diabulimia, and were made available in English-language peer-reviewed journals between January 1, 2000 and August 31, 2022. Exclusion criteria included partial articles, editorials, reviews, and abstracts along with studies of patients with type 2 diabetes. FINDINGS: Over forty individual participants across twelve studies were found to have aspects of their experiences that met one or more criteria from the Diabetes Distress Scale. Participants reported experiences that matched criteria items from each of the seven subscales of the Diabetes Distress Scale. Participants in the twelve studies included 185 individuals with type 1 diabetes experiencing diabulimia, including 164 females (88.6%), 20 males (10.8%), and 1 non-reported gender (0.54%). CONCLUSION: We believe this discovery warrants further research probing the prevalence of diabetes distress among people with diabulimia as well as other links between the two conditions. We advocate for a diabetes distress-informed approach to diabulimia treatment and for diabetes distress screening in every patient with type 1 diabetes.

Development of the diabulimia knowledge level scale.

The aim of this study was to develop the Diabulimia Knowledge Level Scale. The nurses voluntarily participated in the research (n = 384). The Diabulimia Knowledge Level Scale consists of 19 items and four factors. The four factors that make up the scale according to the results of Exploratory Factor Analysis explain 68.53 % of the total variance. The total Cronbach alpha coefficient of the scale was found to be 0.92. The Diabulimia Knowledge Level Scale is the first scale developed to determine the level of diabulimia knowledge among nurses. The scale is valid and reliable.

Depression, anxiety, eating problems, and diabulimia risk in adolescents with type 1 diabetes: a case-control study.

OBJECTIVES: Type 1 diabetes (T1D) causes psychological distress, negatively impacting normal childhood activities. Depression, anxiety disorders, and eating problems are commonly observed in this population. METHODS: The study population consisted of 40 adolescents (22 females and 18 males) who had been diagnosed with T1D and 41 healthy adolescents (21 females and 20 males). The aim of this study was to compare adolescents with T1D to healthy controls in terms of depression, anxiety, and eating problems and subsequently examine the T1D group in relation to the risk of diabetes-specific eating disorders. Eating Attitudes Test (EAT-40), Revised Children's Anxiety and Depression Scale (RCADS), and Diabetes Eating Problem Survey - Revised (DEPS-R) scales were used to compare the case and control groups. RESULTS: The case group exhibited significantly higher scores in EAT-40 total score, RCADS parent form major depressive disorder (MDD), social anxiety disorder (SAD), generalized anxiety disorder (GAD), panic disorder (PD), total anxiety score, total scale scores, RCADS child form MDD, PD, and total scale scores compared to the control group. Individuals at high risk of diabetes-specific eating disorder within the case group demonstrated significantly higher RCADS (child and parent form) MDD scores and RCADS parent form separation anxiety (SA) and total scale scores. Binary logistic regression analysis revealed that the RCADS parent form total scale score could predict DEPS-R. CONCLUSIONS: Routine screening of children and adolescents diagnosed with T1D for depression, anxiety, and eating disorder risk may facilitate early detection of possible psychopathologies, allowing for early intervention to address factors that may disrupt treatment adherence. Further longitudinal studies with larger samples are needed to investigate psychopathologies, particularly eating disorders, in children and adolescents with T1D.

Diabulimia: A Risky Trend Among Adults with Type 1 Diabetes Mellitus.

OBJECTIVE: Poor adherence leads to worse glycemic control and increased complications in patients with type 1 diabetes mellitus (T1DM). Diabulimia characterizes patients with T1DM who skip or use less insulin for weight loss purposes. The study objectives were to determine: (1) the prevalence of diabulimia among adult patients with T1DM, (2) compare patients with and without diabulimia, and (3) identify factors that may place individuals at higher risk of diabulimia. METHODS: A 40-item, web-based survey was administered to 21 T1DM discussion boards, Listservs, and social media outlets. The survey assessed demographics, diabetes management, psychiatric diagnoses, and screened for diabulimia. Individuals who reported intentionally skipping or using less insulin than directed for the purpose of weight loss or to prevent weight gain in the past 12 months were classified as having diabulimia. RESULTS: Of the 225 participants who completed the survey, 8.9% had diabulimia. Patients with diabulimia had elevated hemoglobin A1C (A1C) levels (8.4% vs 6.9%; P = .014), higher rates of a diabetes-related emergency department visits or hospitalization (30.0% vs 13.2%; P = .042), and higher rates of a major depressive disorder diagnosis (40.0% vs 11.5%; P < .001) than patients without diabulimia. Factors associated with diabulimia included high A1C levels (odds ratio, 1.43; 95% CI [1.08-1.91]; P = .014) and a major depressive disorder diagnosis (odds ratio, 4.87; 95% CI [1.31-18.22]; P = .018). CONCLUSION: Approximately 1 in 11 adult patients with T1DM screened positive for diabulimia. Higher A1C levels and a diagnosis of major depressive disorder were associated with diabulimia.

An integrative model as a step toward increasing the awareness of eating disorders in the general population.

Eating disorders (EDs) represent a contradictory chapter of clinical psychiatry, i.e., although they are associated with significant prevalence and risks in the long term (including vital risk, especially for anorexia nervosa), the therapeutic resources are minimal and based on low-quality data. Another contradiction arose in the last few decades, i.e., a variety of new EDs have been described, either by clinicians or signaled by mass media, but their systematic exploration is progressing very slowly. Entities like "food addiction," "orthorexia nervosa," or "emotional eating disorder" still require intensive exploration in order to find the most accurate diagnostic instruments, diagnosis criteria, prevalence data, vulnerability factors, and therapeutic approaches. This article is focused on integrating into a comprehensive model a variety of EDs not specified or loosely defined by the current international classifications of psychiatric disorders. This framework is intended as an instrument for stimulating clinical and epidemiological research, with potential favorable consequences for therapeutic research. The dimensional model suggested here includes four main categories that accommodate the already recognized EDs (i.e., anorexia nervosa, bulimia nervosa, and binge eating disorder) as well as ten EDs that still need intensive research to find their clinical and pathophysiological characteristics. More good-quality studies are urgently required regarding this topic, based on the mental and physical negative impact these EDs may have in the short and long term, especially in vulnerable populations (e.g., pregnant women, athletes, adolescents, etc.).

Diabetes-specific eating disorder and possible associated psychopathologies in adolescents with type 1 diabetes mellitus.

PURPOSE: It was aimed to investigate the frequency of the risk of diabetes-specific eating disorder (DSED) in adolescents with type 1 diabetes mellitus (T1DM) and to reveal the accompanying psychopathologies. METHODS: Adolescents with T1DM aged 12-18 who applied to the pediatric diabetes outpatient clinic between July 2021 and March 2022 were included. Diabetes Eating Problem Survey-Revised (DEPS-R) was applied to all patients to determine the risk of DSED. In order to detect accompanying psychopathologies, Eating Disorder Examination Questionnaire (EDE-Q), Child Anxiety and Depression Scale-Child version (RCADS) and Parenting Style Scale were applied. After completing the scales, semi-structured interviews were conducted with all patients by a child and adolescent psychiatrist. RESULTS: Ninety-two adolescents (45 boys, 47 girls) were included. DSED risk was found in 23.9% of the cases. A positive correlation was found between DEPS-R and EDE-Q scores (p = 0.001, rho = 0.370). RCADS mean scores were significantly higher in the group with DSED risk (p < 0.001). When the Parenting Style Scale was evaluated, psychological autonomy scores were significantly lower in the group with DSED risk (p = 0.029). As a result of the psychiatric interviews, 30 (32.6%) patients had at least 1 psychiatric disorder. Of these, 2 patients were diagnosed with eating disorder. CONCLUSION: Almost one-fourth of adolescents with T1DM were found to be at risk of DSED. Routine screening of adolescents with T1DM with the DEPS-R scale may provide early detection of DSED, and referral of those at risk to child psychiatry enables early diagnosis and intervention for both eating disorders and accompanying psychopathologies. LEVEL OF EVIDENCE: Level III: Evidence obtained from cohort or case-control analytic studies.

High prevalence with no gender difference of likely eating disorders in type 1 mellitus diabetes on insulin pump.

AIM: The aim of this study was to determine the prevalence of likely eating disorders and insulin misuse in a prospective cohort of adults with type 1 diabetes mellitus (T1DM) treated with insulin pump therapy. METHODS: This prospective study was held at the participants' home. The participants completed the SCOFF questionnaire as well as a question related to insulin misuse. Information about lifestyle, medical history, insulin pump and Continuous Glucose Monitoring (CGM) data were collected. RESULTS: The analysis covered 198 participants with a median age of 51 [95% CI 38; 62] years. The prevalence of likely eating disorders was 21.7% (95% CI 16.3; 28.2) in the study population and 20.6% (95% CI 14.3; 28.6) and 24.2% (95% CI 14.6; 37.0) in males and females respectively. The prevalence of insulin misuse was 39.0% (95% CI 30.8; 47.7). There was no significant difference in prevalence between males and females for likely eating disorders and insulin misuse. The analysis of CGM data revealed no factors related to glycaemic control associated with likely eating disorders. CONCLUSION: The results of this study indicate that the prevalence of likely eating disorders is high even in a middle-aged population with a T1DM and satisfactory glucose control.

Insulin restriction or omission in Type 1 Diabetes Mellitus: a meta-synthesis of individuals' experiences of diabulimia.

OBJECTIVE: Unique to individuals with insulin-dependent diabetes mellitus is a disordered eating behaviour whereby insulin is deliberately restricted or omitted. Despite growing research in this area, experiential perspectives of individuals remain understudied. Therefore, this meta-synthesis sought to explore the experiences of individuals with Type 1 Diabetes Mellitus by identifying, analysing and synthesising existing knowledge concerning this misuse of insulin. DESIGN: Meta-aggregative techniques were employed to generate synthesised findings related to individuals' understanding and experience, physical and psychological impacts, support and treatment-related needs, noted in twelve studies. RESULTS: A multifaceted relationship with insulin misuse, beyond weight control was identified. Many individuals experienced diabetes-related complications alongside increased distress, loss of control and feelings of regret, guilt, and shame. Almost all individuals valued support from those who shared a 'diabulimic' identity; peer support appeared more conducive to recovery than support from others including formal support services. CONCLUSIONS: This meta-synthesis highlights the need for empathic, collaborative care, and proactive prevention and intervention. The findings highlight the value of peer support, the need for increased knowledge among informal supports, training among multidisciplinary teams and support services, and crucially the development of evidence-based treatments informed by the behaviour as a unique distinct construct.

Higher score of diabetes eating problem survey-revised (DEPS-R) is associated with poor glycemic control among Brazilian patients with type 1 diabetes (T1DM): A brief report.

BACKGROUND AND AIMS: The diabetes eating problem survey-revised (DEPS-R) questionnaire is a specific and valuable tool for assessing disturbed eating behavior in type 1 diabetes mellitus. The literature suggests an association between a higher DEPS-R score and worse metabolic control; however, these figures have not been described in patients from Latin America. METHODS: We evaluated 58 patients with type 1 diabetes mellitus from a Brazilian outpatient clinic using the DEPS-R questionnaire. RESULTS: Overall, 23 participants with a high risk for high eating disorder behaviors exhibited significantly increased hemoglobin A1c levels compared with 35 patients with a DEPS-R score <20. CONCLUSIONS: Our data support that the presence of a DEPS-R score >20 negatively affects the metabolic control of patients with type 1 diabetes mellitus in Brazil.

Caring for individuals with Type 1 Diabetes Mellitus who restrict and omit insulin for weight control: Evidence-based guidance for healthcare professionals.

PURPOSE: Evidence-based guidance is needed to inform care for individuals with Type 1 Diabetes Mellitus who deliberately restrict and omit insulin for weight control. Consensus on the best treatment approach for these individuals is currently lacking, and standard eating disorder treatment protocols are ineffective. This article focuses on how healthcare professionals can provide meaningful care to this population. METHODS: Qualitative research studies were synthesised in a meta-aggregative meta-synthesis. We identified key themes related to individuals' understanding and experience, physical and psychological impacts, support and treatment-related needs and experiences. These themes guided the development of implications for practice. RESULTS: Individuals engaging in insulin misuse wanted healthcare professionals to demonstrate more empathy, validate their experiences, have increased knowledge about their illness and develop more specialist pathways. CONCLUSIONS: The findings have widespread interdisciplinary implications for health professionals working with individuals with Type 1 Diabetes Mellitus. Evidence-informed implications for practice are provided and may provide useful guidance concerning the prevention and treatment of this unique behaviour.

The Diabetes Eating Problem Survey-Revised (DEPS-R) in a Greek Adult Population with Type 1 Diabetes Mellitus: Model Comparison Supporting a Single Factor Structure.

Type 1 diabetes mellitus (T1DM) patients occasionally develop disordered eating behaviors, leading to insulin manipulation without medical consultation, targeting to achieve weight control. In clinical practice, the Diabetes Eating Problem Survey-Revised Version (DEPS-R) questionnaire has been used to evaluate eating disorders in T1DM patients. This study was conducted to validate the factor structure of the Greek version of DEPS-R using Confirmatory Factor Analysis (CFA), to investigate its reliability and convergent validity in Greek T1DM adults and to compare a single factor DEPS-R model with multiple factor models. Participants were 103 T1DM adults receiving insulin, who responded to DEPS-R. Their anthropometric, biochemical and clinical history data were evaluated. The sample presented good glycemic control and 30.1% scored above the established DEPS-R cut-off score for disturbed eating behavior. CFA results revealed that the data fit well to the factor models. The DEPS-R scale had good reliability and was positively linked to BMI, HbA1c, total daily dose and time in range. Model comparison supported the superiority of the 1-factor model, implying that Greek clinicians and practitioners might not have to consider individualized treatment based on various scores across different subscales but they can adopt a single DEPS-R score for an easy and efficient screening for disordered eating.

A review of risk factors associated with insulin omission for weight loss in type 1 diabetes.

Research suggests that as many as 60% of people with type 1 diabetes (T1D) admit to misusing insulin. Insulin omission (IO) for the purpose of weight loss, often referred to as diabulimia, is a behaviour becoming increasingly recognised, not least since prolonged engagement can lead to serious vascular complications and mortality. Several risk factors appear to be relevant to the development of IO, most notably gender, anxiety and depression and increased weight concerns and body dissatisfaction. Evidence suggests that women, especially young girls, are more likely to omit insulin as a method of weight loss compared to men. Mental health conditions such as anxiety and depression are increasingly prevalent in people with T1D compared to their peers, and appear to contribute to the risk of IO. Increased weight concerns and body dissatisfaction are further prominent risk factors, especially given increases in weight which often occur following diagnosis and the monitoring of weight by diabetes teams. This review presents evidence examining these risk factors which increase the likelihood of a person with T1D engaging in IO and highlights the complications associated with prolongment of the behaviour. Further research looking at the comorbidities of these risk factors, alongside other factors, would provide greater insight into understanding IO in people with T1D.

Diabetes and eating disorders: an exploration of 'Diabulimia'.

BACKGROUND: 'Diabulimia' is the term given to the deliberate administration of insufficient insulin for the purpose of weight loss. Although Diabulimia can be life-threatening and prevalence rates in diabetes are high, there is a lack of research for how to effectively support people with the condition. This exploratory study aimed to provide much-needed information to healthcare professionals and guide the focus for future research. METHODS: Forty-five individuals with Type 1 diabetes mellitus (T1DM) and a history of insulin misuse completed an online questionnaire. This included an assessment of their eating disorder psychopathology with the Eating Disorder Examination Questionnaire (EDE-Q) and 16 open-ended questions exploring their experience of Diabulimia. The responses to the open-ended questions were analysed using thematic analysis. RESULTS: The average global EDE-Q score was 3.96 (1.21), which is consistent with eating disorder populations. Common themes identified were concerns about weight, difficulty coping with diabetes, past trauma, and the importance of relationships. Experiences with health professionals were overwhelmingly negative. Most participants had experienced serious medical intervention due to Diabulimia and were fully aware of the consequences of insulin restriction. CONCLUSIONS: Overall, individuals believed that a greater awareness of Diabulimia and more training for healthcare professionals is needed. While education on insulin misuse may be a necessary first step in treatment, psychological support is crucial. To deliver effective treatment, clinicians should be aware of the specific issues facing those with Diabulimia. The current study identified themes that clinicians may find useful to consider.

Eating Disorders and Diabetes.

PURPOSE OF REVIEW: This review describes the characteristics of patients with eating disorders in both type 1 and type 2 diabetes and the principles of their treatment. RECENT FINDINGS: The combination of type 1 diabetes and an eating disorder is sometimes known as "diabulimia". The hallmark of the condition is that the patient deliberately takes an inadequate amount of insulin in order control their body weight (insulin restriction). Other disordered eating behaviours, such as dietary restriction, self-induced vomiting and binge eating, may also be present but typical anorexia nervosa is rare. There is an increased prevalence of eating disorders in adolescents with type 1 diabetes, which is estimated at 7%. The combination of type 1 diabetes and an eating disorder leads to elevated levels of HbA1c and an increased risk of both acute and chronic complications. Screening is recommended but rarely carried out. Management requires an understanding of the inter-relationships between eating behaviour, mood, blood glucose and insulin administration. Treatment aims to introduce a regular eating pattern and support the patient to increase their insulin dose gradually. Eating disorders also occur in those with type 2 diabetes, where binge eating disorder is the most common diagnosis. Eating disorders are common in both type 1 and type 2 diabetes, with an increased prevalence of complications in type 1. Treatment requires an understanding of both diabetes and eating behaviour.

Comportamiento clínico y enfoque terapéutico de los trastornos alimentarios en personas con diabetes mellitus tipo 1 / Clinical Behavior and Therapeutic Approach of Eating Disorders in People with Type 1 Diabetes Mellitus

Introducción: El comportamiento clínico de la diabetes mellitus tipo 1 y el enfoque terapéutico de los trastornos de la conducta alimentaria se complejizan cuando estos coinciden en una misma persona. Objetivo: Describir algunos aspectos del comportamiento clínico y enfoque terapéutico de los trastornos de la conducta alimentaria en personas con diabetes mellitus tipo 1. Métodos: Se realizó una búsqueda de literatura relevante sobre el tema en el primer semestre de 2019. Se utilizaron como buscadores de información científica a Pubmed y a Google Académico. Como criterios iniciales de elegibilidad, se evaluaron artículos de revisión, de investigación y páginas Web que, en general, tenían menos de 10 años de publicados, en idioma español, portugués e inglés, y que hicieran referencia específicamente al tema de estudio a través del título. Fueron excluidos los artículos que no cumplieron con estas condiciones. Esto permitió el estudio de 65 artículos, de los cuales 33 fueron referenciados. Conclusiones: El comportamiento clínico de los trastornos de la conducta alimentaria en pacientes con diabetes mellitus tipo 1 combina síntomas y signos propios de ambas dolencias. Ambas entidades nosológicas se deben prevenir, pesquisar, diagnosticar e intervenir desde los servicios de atención primaria de salud, a través de una perspectiva interdisciplinaria. El tratamiento endocrinológico, unido a la terapia individual, la psicoeducación relacionada con los trastornos de la conducta alimentaria, la terapia familiar y un plan de tratamiento integral para la salud mental son imprescindibles desde el primer nivel de atención(AU)

Introduction: The clinical behavior of type 1 diabetes mellitus and the therapeutic approach to eating disorders become more complex when they coincide in the same person. Objective: To describe some aspects of the clinical behavior and therapeutic approach of eating disorders in people with type 1 diabetes mellitus. Methods: A search of relevant literature on the subject was carried out in the first semester of 2019. We used, as search engines for scientific information, Pubmed and Google Scholar. As initial eligibility criteria, we evaluated review articles, research articles, and web pages which, in general, were published less than 10 years ago, in Spanish, Portuguese and English, and which made, in their titles, specific reference to the topic of the study. Articles that did not meet these conditions were excluded. This allowed the study of 65 articles, of which 33 were referenced. Conclusions: The clinical behavior of eating disorders in patients with type 1 diabetes mellitus combines symptoms and signs typical of both conditions. Both nosological entities must be prevented, screened, diagnosed and intervened, starting in primary health care services, through an interdisciplinary perspective. Endocrinological treatment, together with individual therapy, eating disorders-related psychoeducation, family therapy, and a comprehensive treatment plan for mental health are essential, starting in the first level of care(AU)

Hacia un definición y consenso del término "diabulimia" / Toward a definition and consensus of the term "diabulimia"

RESUMEN Introducción: El vocablo "diabulimia" resulta de la combinación de dos palabras, diabetes mellitus y bulimia. Una de las características de los pacientes afectados es la restricción deliberada de insulina, con el objetivo de controlar el peso corporal. Objetivo: Describir la definición y consenso actual acerca del término diabulimia. Métodos: Se realizó una búsqueda de la literatura relevante sobre el tema. Se utilizaron como buscadores de información científica a Pubmed y a Google Académico. Como criterios de elegibilidad, se evaluaron artículos de revisión, de investigación y páginas Web que, en general, tenían menos de 10 años de publicados, en idioma español, portugués e inglés, que hicieran referencia específicamente al tema de estudio, y que abordaran la temática a través de cualquier metodología de investigación (cuantitativa, cualitativa, investigación operativa, otras). Fueron excluidos los artículos que no cumplieron con estas condiciones. Esto permitió el estudio de 33 artículos, de los cuales 20 son referenciados en el presente artículo. Conclusiones: La descripción del vocablo diabulimia genera retos importantes. Existen diferentes definiciones, lo cual tiende a confundir a los pacientes e inclusive a los profesionales de la salud. En la actualidad, aun no se ha logrado consensar esta definición, por lo cual continuará siendo un término coloquial y no será reconocido oficialmente como una enfermedad. Reconocer la relevancia del tema y poder identificar indicadores de su presencia es importante, pues su padecimiento expone a los pacientes con diabetes mellitus a efectos deletéreos sobre su salud y calidad de vida(AU)

ABSTRACT Introduction: The term "diabulimia" results from the combination of two words: diabetes mellitus and bulimia. One of the characteristics of the patients affected is the deliberate restriction of insulin with the aim of controlling body weight. Objective: To describe the definition and current consensus on the term diabulimia. Methods: It was carried out a search of important literature on the subject. There were used as search engines of scientific information Pubmed and Google Scholar. As eligibility criteria, there were assessed review articles, research and web pages that, in general, were less than 10 years of been published, in Spanish, Portuguese and English languages, which would make specific reference to the studied topic, and that would address the issue through any research methodology (quantitative, qualitative, operations research, others). There were excluded the articles that did not comply with these conditions. This allowed the study of 33 articles, of which 20 are referenced in this article. Conclusions: The description of the term diabulimia generates significant challenges. There are different definitions, which tends to confuse patients and even health professionals. At present, it has not been possible to achieve a consensus on this definition that is why it will continue to be a slang term and will not be officially recognized as a disease. It is important to admit the relevance of diabulimia and to be able to identify indicators of its presence, since this condition exposes patients with diabetes mellitus to deleterious effects on their health and quality of life(AU)

Efecto del diagnóstico de la diabetes mellitus y su complicación con los trastornos de la conducta alimentaria / The effect of diabetes mellitus diagnosis and its complication with eating disorders

RESUMEN El diagnóstico de la Diabetes Mellitus (DM) para ciertas personas puede puede llegar a ser un momento de estrés intenso producto del impacto psicosocial que genera su diagnóstico, además de una exigencia exagerada por mantener el peso dentro de un rango normal estilo de vida extremadamente saludable. Producto de lo anterior existen sujetos que tienen una alta probabilidad de padecer Trastornos de la Conducta Alimentaria (TCA), que son un conjunto de enfermedades mentales crónicas y complejas en donde se presenta una elevada preocupación por la comida, el peso y/o imagen corporal y el uso de conductas compensatorias no saludables con el objetivo de controlar el peso. El objetivo de este trabajo fue revisar la bibliografía disponible con respecto al manejo y tratamiento de la DM y cómo puede gatillar en ciertos tipos de TCA. Describiendo el peligro metabólico de su coexistencia, como se desarrolla y cómo se manifiestan en los sujetos. Ya que se observa que el tratamiento impuesto y recomendado en la actualidad está generando el escenario propicio para la presencia de los TCA. Lo cual hoy en día es una enfermedad que va en aumento y genera un riesgo mortal en las personas que la padecen.

ABSTRACT The diagnosis of Diabetes Mellitus (DM) can, for some, become a time of intense stress due to the psychosocial impact generated by the diagnosis, in addition to an exaggerated demand for maintaining weight in a normal range an extremely healthy lifestyle. Thus, some persons have a high probability of suffering from a Eating Disorder (ED), which is a chronic and complex mental illness where there is a high concern for food, weight and / or image and the use of unhealthy compensatory behaviors in order to control weight. The objective of this work was to review the available literature regarding the management and treatment of DM and how it can trigger certain types of ED. We also describe the metabolic danger of their coexistence, how ED develops and how it is manifested. We argue that current recommended treatment generates a favorable scenario for the presence of ED, which today is a disease that is increasing and represents a mortal risk among people who suffer from it.

Psychosocial aspects of diabetes management: dilemma of diabetes distress.

Diabetes mellitus (DM) is a debilitating chronic illness with complex pathophysiological, psychological, and quality of life (QoL) implications creating a constant state of turbulence. Some of these interconnections are apparent to healthcare providers and are easily addressed in a routine diabetic clinical care. However, a large number of these hidden factors that interplay with each other and impact on the physical outcomes of DM goes unnoticed by health care providers. This is a frustrating and lonely predicament for DM patients making it very difficult for them to manage their illness well. At times these patients are mislabeled as "difficult patients". In other cases they are considered to have and unnecessarily treated for psychiatric illness like depression, other mood or anxiety spectrum disorders which they may not need. In recent years clinical researcher are making strides in understanding the emotional distress a DM patient may feel and the factors contributing or perpetuating diabetes distress. This article focuses on understanding the diabetes distress and how it impacts our patients, how to screen, assess, treat and eventually prevent it from happening. The paper also attempt to bring out the major differences between diabetes distress and common psychiatric comorbidities of DM including but not limiting to major depressive disorder and other depression spectrum disorders.

Diabetes, eating disorders and body image in young adults: an exploratory study about "diabulimia".

PURPOSE: The purpose of this study was to compare disordered eating (DE) and body image dissatisfaction (BID) among young adults with type 1 diabetes and their peers without diabetes, to investigate the consequences of diabetes for food, body image and weight in individuals with diabetes and to identify the behavior of insulin omission as a weight loss strategy. METHODS: Fifty-five young adults with diabetes and 73 without diabetes (ages 18-30) completed self-report questionnaires to evaluate their behaviors, attitudes and feelings related to eating disorders and their perceptions about body image. The participants with diabetes were asked to answer a questionnaire with open and closed questions developed specifically for this study. RESULTS: No significant differences between participants with and without diabetes in relation to BID and DE were found. The results demonstrated several changes resulting from diabetes in terms of food, body image and weight that interfere with the day-to-day life of individuals with diabetes; 7.3% of these participants reported insulin omission as a weight loss strategy. CONCLUSIONS: This study emphasizes the importance of research on DE in the population with diabetes and their prevention, screening and treatment. In particular, it is essential to give more attention to insulin omission as a compensatory behavior that is inappropriate and harmful to health. LEVEL OF EVIDENCE: Level III, case-control analytic study.